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Abstrak :
[ABSTRAK
Tumor otak (TO) merupakan penyebab kematian kedua dari semua kanker yang terjadi pada anak. TO memiliki gambaran klinis, radiologis dan histopatologis yang sangat bervariasi karena proses pengembangan sel-sel jaringan otak masih berlanjut sampai usia 3 tahun. Data penelitian mengenai TO pada anak masih sedikit. Tujuan: Untuk mengetahui gambaran klinis, radiologis, histopatologis dan faktor prognostik TO di Departemen Ilmu Kesehatan Anak FKUI/ RS. Dr. Ciptomangunkusumo Jakarta periode tahun 2010 - 2015. Metode Penelitian: Kohort retrospektif dilakukan pada semua anak dengan TO primer yang berobat/dirawat di Departemen Ilmu Kesehahatan Anak FKUI/RS Dr. Ciptomangunkusumo Jakarta. Hasil: Didapatkan 88 pasien TO primer, terdiri dari 16 pasien berusia kurang dari 3 tahun dan 72 pasien berusia lebih dari 3 tahun, laki-laki 53% dan perempuan 47%. Anak usia kurang dari 3 tahun mengalami gejala sakit kepala (63%) dan kejang (56%), berdasarkan radiologis letak TO yang terbanyak adalah di cerebral ventrikel (25%) dan cerebellum (24%), berdasarkan histopatologis jenis TO yang terbanyak adalah Astrositoma (31%) dan Medulloblastoma (25%). Anak usia lebih dari 3 tahun mengalami gejala sakit kepala (81%) dan gangguan penglihatan (65%), berdasarkan radiologis letak TO yang terbanyak adalah di cerebellum (24%) dan suprasellar (10 %), berdasarkan histopatologis jenis TO yang terbanyak adalah Medulloblastoma (21%), Astrositoma (18%) dan Glioma (17%). Angka kehidupan TO adalah 37 %. Tidak didapatkan faktor prognostik TO yang bermakna. Kesimpulan: Gejala TO tersering adalah sakit kepala, berdasarkan radiologis letak tumor terbanyak adalah di cerebellum serta berdasarkan histopatologis jenis tumor terbanyak adalah Medulloblastoma dan Astrositoma. Tidak didapatkan faktor prognostik TO pada anak.

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ABSTRACT
Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.;Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor., Background: Primary brain tumors rank second as the most frequent neoplasm in children. The lesions occurring in neonates or infants have been reported to differ from those in older children in terms of their clinical presentation, radiology and histopathology features. Objective To clarify the clinical presentation, radiology, histopathology features. and prognostic factor of primary brain tumors in Child Department Ciptomangunkusumo Hospital Jakarta in 2010 - 2015. Method: Retrospective cohort using medical records and neuroradiological dan histopathological studies, we analyzed each patient?s clinical presentation, tumor location, histopathological diagnosis and treatment then we compared between under 3 years of age and more 3 years of age . The patients were followed until their death or until the end of October 2015. Result: 88 patient of primer brain tumor that consist of 16 patients with under 3 years of age and 72 patients with more 3 years of age. Boys are 53% and girls are 47% . The most symptoms of children under 3 years of age is headache (63%) and seizure (56%), based on radiology the most location tumor is cerebral ventrikel (25%) and cerebellum (24%), based on histopathology the predominant tumor is Astrositoma (31%) and Medulloblastoma (25%). The most symptoms of children more 3 years of age is headache (81%) and visual difficulties (65%), based on radiology the most tumor location is cerebellum (24%) and suprasellar (10 %), based on histopathology the predominat tumor is Medulloblastoma (21%), Astrositoma (18%) and Glioma (17%). The life expectancy rate is 37 %. There is no prognostic factor of brain tumor. Conclusion: The most symptom of brain tumor is headache, based on radiology the most tumor location is cerebellum, and based on histopathology the predominant tumor is Medulloblastoma and Astrositoma. There is no prognostic factor of brain tumor.]

Abstrak :
Tujuan: Mengetahui kualitas hidup pasien anak dengan tumor otak yang telah menjalani radioterapi di Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo berdasarkan PedsQL™ 4.0 skala generik serta mengetahui kesintasannya serta faktor risiko yang berpengaruh terhadap mortalitas. Metode: Dilakukan studi dengan desain potong lintang yang melibatkan 88 pasien dan sebanyak 26 diantaranya turut serta dalam penilaian kualitas hidup dengan menggunakan instrumen Pediatric Quality of Life Infentory (PedsQL™) 4.0 skala generik. Hasil: Dari 88 pasien yang terlibat dalam penelitian ini, sebanyak 31 pasien loss to follow up, 28 pasien terkonfirmasi meninggal, dan 29 pasien terkonfirmasi hidup. Kesintasan (OS) 1 tahun, 3 tahun, dan 5 tahun beturut-turut sebesar 71,6 %, 43,2%, dan 5,7%. Lokasi tumor infratentorial dan usia yang lebih muda pada saat diagnosis merupakan faktor risiko yang dapat meningkatkan mortalitas pada pasien anak dengan tumor otak pasca radioterapi dengan nilai p 0,044 dan 0,036. Nilai rerata kualitas berdasarkan laporan anak dan laporan orang tua PedsQL™ 4.0 skala generik adalah sebesar 70,686 dan 70,152. Penghasilan keluarga ≥ Rp 4.200.000,00 merupakan faktor yang meningkatkan kualitas hidup anak dengan tumor otak pasca radioterapi (p=0,008). Kesimpulan: Kualitas hidup pada pasien anak dengan tumor otak pasca radioterapi dapat dipengaruhi oleh faktor sosioekonomi yaitu penghasilan keluarga. Lokasi tumor dan usia yang lebih muda saat didiagnosis dapat meningkatkan risiko mortalitas. ......Aims: This study was aimed to show the quality of life in children with brain tumor after radiotherapy in Dr. Cipto Mangunkusumo National General Hospital based on PedsQL™ 4.0 generic core scale. This study was also aimed to show the overall survival and mortality risk factors. Methods: This cross-sectional study consisted of 88 children with brain tumor after radiotherapy. There were 26 of 88 children assessed by PedsQL™ 4.0 generic core scale. Results: Of the 88 patients involved in this study, 31 patients lost to follow-up, 28 patients were confirmed dead, and 29 patients were confirmed alive. One year, 3 years, and 5 years overall survival were respectively 71.6%, 43.2%, and 5.7%. Infratentorial tumor location and younger age at diagnosis were risk factors that can increase the incidence of mortality (p= 0.044 and 0.036). Children’s quality of life were 70.686 and 70.152 based on PedsQL ™ children and parents' reports. Family income ≥ IDR 4,200,000.00 was a factor that improved the quality of life in children with brain tumors after radiotherapy (p = 0.008). Conclusion: Quality of life in pediatric patients with brain tumor after radiotherapy could be influenced by family income. The location of the tumor and the younger age at diagnosis could increase the risk of mortality.

Abstrak :
Penelitian ini bertujuan untuk mengevaluasi perhitungan dosis berdasarkan citra Cone Beam Computed Tomography (CBCT) pada pasien dengan diagnosa tumor otak. Perencanaan dan perhitungan dosis berdasarkan citra CBCT fraksinasi ke-16 yang dilakukan terhadap 13 pasien yang disinari menggunakan pesawat linac Elekta Versa HD dan 7 pasien yang disinari menggunakan pesawat linac Halcyon 2.0. Perencanaan dan perhitungan dosis dilakukan pada Treatment Planning System (TPS) Eclipse dan TPS Monaco. Hasil perhitungan dosis berdasarkan citra CBCT dibandingkan dengan citra Computed Tomography (CT) simulator. Penelitian ini memiliki beberapa tahapan, (1) kalibrasi Hounsfield Unit (HU) citra CBCT menggunakan fantom CIRS CT electron density 062M untuk melakukan perhitungan dosis di TPS dengan nilai HU yang sesuai, (2) proses pengumpulan data citra pasien yang memenuhi kriteria penelitian dan dilanjutkan dengan proses registrasi dan perencanaan citra CBCT, (3) analisis Dose Volume Histogram (DVH) untuk mengevaluasi kualitas perencanaan dengan parameter dosis yaitu Conformity Index (CI) dan Homogeneity Index (HI), (4) analisis dosis Organ at Risk (OAR) terhadap dose-constraint (batas dosis) untuk OAR batang otak, kiasma, sumsum tulang belakang, saraf optik, mata dan lensa. Nilai CI pada perencanaan berdasarkan CT tidak berbeda secara signifikan, Berdasarkan CBCT dari pesawat linac Elekta Versa HD diperoleh CI sebesar 0,05±0,21 (p=0,08) dan -0,01 ± 0,06 (p=0,02) berdasarkan CBCT dari pesawat linac Halcyon 2.0. Sementara itu, nilai HI pada perencanaan berdasarkan CBCT diamati berbeda secara signifikan terhadap CT, Berdasarkan CBCT dari pesawat linac Elekta Versa HD diperoleh HI sebesar 0,25 ± 0,43 (p=0,01) dan 0,08 ± 0,04 (p=0,01) berdasarkan CBCT dari pesawat linac Halcyon 2.0. ......This research aims to evaluate dose calculations based on Cone Beam Computed Tomography (CBCT) images in patients diagnosed with brain tumors. Planning and dose calculations based on the 16th fraction of CBCT images were performed on 13 patients irradiated using Elekta Versa HD linear accelerator and 7 patients irradiated using Halcyon 2.0 linear accelerator. The planning and dose calculations were conducted using the Treatment Planning System (TPS) Eclipse and TPS Monaco. The results of the dose calculations based on CBCT images were compared with the Computed Tomography (CT) simulator images. The research comprised several stages: (1) calibration of Hounsfield Unit (HU) of CBCT images using CIRS CT electron density 062M phantom to perform dose calculations in TPS with appropriate HU values, (2) data collection of patient images meeting the research criteria followed by image registration and CBCT planning, (3) analysis of Dose Volume Histogram (DVH) to evaluate planning quality using dose parameters such as Conformity Index (CI) and Homogeneity Index (HI), (4) analysis of dose to Organs at Risk (OAR) against dose constraints for OARs such as brainstem, chiasm, spinal cord, optic nerves, eyes, and lenses. The CI values for the planning based on CT were not significantly different. Based on CBCT from Elekta Versa HD linear accelerator, the CI obtained was 0.05 ± 0.21 (p=0.08), and based on CBCT from Halcyon 2.0 linear accelerator, the CI obtained was -0.01 ± 0.06 (p=0.02). However, the HI values for planning based on CBCT significantly differed from CT. Based on CBCT from Elekta Versa HD linear accelerator, the HI obtained was 0.25 ± 0.43 (p=0.01), and based on CBCT from Halcyon 2.0 linear accelerator, the HI obtained was 0.08 ± 0.04 (p=0.01).

Abstrak :
ABSTRAK
Peningkatan kualitas citra medis khususnya untuk bagian kepala manusia terus dikembangkan, termasuk dengan pemodelan 3D. Hal ini dilakukan untuk mengurangi kesalahan dalam proses diagnosa dan memfasilitasi pendeteksian tumor otak dengan pendekatan 3D. Dalam prosesnya, citra MRI otak dianalisa secara 3D sehingga diperoleh bagian tumor otak. Citra MRI dikonversi dari citra berformat MINC. Citra diklasifikasi untuk mendeteksi objek menggunakan K-Means Clustering yang akan memisahkan bagian tumor dan otak. Proses filter dilakukan menggunakan Non-Local Means sehingga noise hasil pengolahan dapat berkurang dari proses sebelumnya. Hasil citra pengolahan disegmentasi untuk meningkatkan dan mendukung proses rekonstruksi menggunakan Thresholding. Terakhir adalah merekonstruksi citra dalam bentuk 3D menggunakan metode Marching Cube. Evaluasi akurasi sistem meliputi pengurangan resolusi, pengujian citra normal, uji perbandingan, penggantian format citra dan penambahan noise. Hasil akurasi pendeteksian tumor otak mencapai 100% untuk format PNG dan resolusi 512x512, 97,7% untuk resolusi 256x256, 96,9% untuk citra normal tanpa tumor dan 97,96% berdasarkan perbandingan data olah dengan data referensi. Format PNG memiliki akurasi dibandingkan format JPEG dengan perbedaan sebesar 4%. Pengujian dengan menambahkan noise menghasilkan akurasi 87,6% untuk densitas 0,01, 83,6% untuk 0,05 dan 74,5% untuk 0,09.

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ABSTRACT
Medical image enhancement especially for human brain imageries is rapidly developed, including 3D modeling. This research is aimed to reduce the error of diagnosis process and facilitate brain tumor detection using 3D approach. In the process, 3D brain from MRI imageries is analyzed to detect brain tumors. MRI image is converted from MINC format. Then, the image is classified to detect objects using K-Means Clustering to divide each part of brain. Filtering is performed using Non-Local Means to remove noise from previous processes. The result of imageries are segmented to enhance and support reconstruction process using Thresholding. Finally, 3D image reconstruction is performed using Marching Cube method. The accuracy of brain tumor detection is evaluated of resolution reduction, non tumor image testing, comparison testing, modifying image format, and adding noise. The accuracy rate of brain tumor detection is 100% for PNG format and 512x512 resolution, 97,7% for 256x256 resolution, 96,9% for non tumor image and 97,96% for comparison between ideal image and reference data. PNG format has better accuracy with JPEG by 4% improvement. The accuracy of adding noise is 87,6% for 0,01 density, 83,6% for 0,05 and 74,5% for 0,09.